Provider Demographics
NPI:1619013026
Name:LEE, BRIAN ANTHONY (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:LEE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14563 NW 22ND PLACE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669
Mailing Address - Country:US
Mailing Address - Phone:352-332-5598
Mailing Address - Fax:
Practice Address - Street 1:726 NW 8TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5094
Practice Address - Country:US
Practice Address - Phone:352-871-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2488OtherBCBS PROVIDER #